Blood components for non-transfusion use in oral surgery

OBJECTIVES Platelet derivates are widely used for tissue regeneration, in dentistry and beyond, with shorter healing time and fewer side effects associated with the surgical trauma or with pathologic conditions. They are autologous products obtained from a little amount of venous blood, through manipulation with closed circuit systems. Among these, L-PRF has a safe and promising use in the dental field. It can be used alone or together with other materials and is, due to its peculiarities, the most used among the blood components in oral surgery. This paper has the aim to make an overview about the various applications of the platelet derivatives in the dental field. Moreover, three clinical cases managed with L-PRF will be presented. MATERIALS AND METHODS Three clinical cases have been selected among those managed at the Oral-Maxillofacial Surgery Unit, at the Policlinico of Modena, Italy. Case 1: one patient with third molar impaction, 3.8. This element, shows a significant sagittal inclination, greater than 50 degrees, and a high impact on the II left molar; these conditions may lead to a periodontal damage to the 3.7. Due to this clinical situation, the surgical extraction of tooth 3.8 has been performed, with the apposition of L-PRF within the residual alveolar socket. Case 2: patient with an osteolytic lesion at the pre-maxilla. After surgical removal of the inflammatory cystic lesion, the residual defect has been filled with L-PRF mixed with particulated bovine deproteinized bone to promote the regeneration of the defect and to make the graft material easier to handle for the operator. At the outer aspect of the lesion L-PRF membranes have been used. Case 3: medical-related osteonecrosis of the lower jaw. After the removal of the necrotic bone and the surgical debridement, L-PRF has been used to obtain filling of the residual bone defect. In this case, L-PRF was used to bring a higher quantity of growth factors to the site and due to its neangiogenetic proprieties, in order to create a good mucous seal and to promote the regeneration of the defect. RESULTS The three cases have been managed with L-PRF. The post-operative sequelae have been very low in terms of incidente and severity. As a matter of fact, we note mild post-operative swelling and mild pain. At 6 months re-evaluation, the mucous seals were all maintained and the soft tissue healing was perfectly achieved. Upon radiographic examination, bone regeneration could be appreciated. CONCLUSIONS Within the limits of this presentation of only three clinical cases we just formulate some first impressions. We can confirm the versatility of L-PRF production and application in oral surgery. These preliminare data goes along with the data already existing in the scientific literature. However, more observational and prospective studies are necessary, in order to provide the practitioner with specific guide-line for the application of L-PRF in the dental field. CLINICAL SIGNIFICANCE The blood components, and among them L-PRF, could be a valid alternative material for tissue regeneration. In a very close future it could lead us to reduce the use of etherologous biomatherials in favour of a completely autologous one, cheaper and potentially very effective. At last, L-PRF in combination with an etherologous graft material could improve its potential and make it easer to handle for the operator itself.